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Lung Adenocarcinoma with Active Aulmonary Tuberculosis: A Case Report of Successful Immunotherapy and Systematical Review

Jinhe Xu1, Xiuhua Lin2, Wei Liu2, Jia Ye2, Zongyang Yu2*, Feilai Xie3, Huimin Deng4, Ming Deng5

Background: Immune Checkpoint Inhibitors (ICIs) have become widely used in the treatment of several malignancies, and get better clinical benefits in some patients with Non-Small Cell Lung Cancer (NSCLC). However, in most of high quality clinical Randomized Controlled Trial (RCT) studies, only selected patients are needed. In Real-World Study (RWS), patients contracted simultaneously with NSCLC and Tuberculosis is common. TB reactivation during ICIs use is increasingly recognized and reported. Whether ICIs can be used in anti-tumor in patients with TB is rarely seen.

Case presentation: Herein, we present a 67-year-old male active tuberculosis complicated with advanced Non-Small Cell Lung Cancer (NSCLC) ALK-negative, EGFR wild, and PD-L1 Immune Histochemistry (IHC) strongly positive in 60%-90% of tumor cells, on ongoing treatment with Pembrolizumab as a firstling anti-tumor therapy during anti-TB treatment. After two cycles of Pembrolizumab, the tumor response was evaluated PR, and TB well controlled. The patient is still on anti-TB and ICIs anti-tumor therapy, sputum smear and sputum culture remains negative, follow-up showed no relapse of tuberculosis infection or tumor progression.

Conclusion: Our study shows that it may be feasible to combine anti-TB with ICIs for advanced lung cancer patients with active TB.

Keywords: Lung adenocarcinoma; Immune Checkpoint Inhibitors (ICIs); Tuberculosis (TB); Pembrolizumab

Abbreviation: ICIs: Immune Checkpoint Inhibitors; NSCLC: Non-Small Cell Lung Cancer; RCT: Randomized Controlled Trial; RWS: Real-World Study; IHC: Immune Histochemistry; WHO: World Health Organization; LC: Lung Cancer; HE: Histological; TTF-1: Examination Thyroid Transcription Factor 1; PD-L1: Programmed Death-Ligand.